Brief overview of gum health and its importance 

Gum health is crucial for overall well-being. Most people are affected by oral diseases like dental caries, periodontal disease (gum disease), and tooth loss, which can impact their general health.¹ Periodontal disease is one of the most significant oral diseases contributing to the global burden of chronic disease.² Good periodontal health is characterized by the absence of disease as clinically assessed, and it is associated with conditions like gingivitis, periodontitis, and other periodontal issues.³

Introduction to grape seed extracts (GSE)

GSE primarily come from grapes, scientifically known as vitis vinifera, and are widely available as food nutrients. They possess numerous properties such as anti-inflammatory, antimicrobial, antioxidant, and more.

Understanding gum health

Anatomy and function of gums

The gums also known as the gingiva are pink-colored keratinized mucosa that surrounds and protects the teeth.⁴ The gingiva is part of the periodontium which makes up the structures that support the teeth.⁴ The periodontium is responsible for supporting and maintaining healthy teeth. It comprises four components: the gingiva, periodontal ligament, alveolar bone, and cementum.⁴

Common gum diseases (gingivitis, periodontitis) 

The primary gum diseases are gingivitis and chronic periodontitis (CP). Both are caused by buildup of bacterial biofilms (also known as dental plaque) at the gum line where the teeth and gums meet.⁵

Gingivitis

Gingivitis is characterised by redness and swelling of the gums which bleed when the teeth are brushed.⁵ Gingivitis occurs mainly due to plaque accumulation and factors responsible for plaque formation and propagation are poor dental oral hygiene.⁶

In chronic periodontitis (CP), dental plaque builds up on the root surface of the tooth beneath the gum line (known as subgingival plaque). As a result, the teeth can become loose and may be lost due to the bone supporting them being destroyed.⁵ Gingivitis being the mildest form of gum disease can be reversed by daily brushing, flossing, and regular cleaning by a dentist. This treatment is called scaling associated with proper medication.⁶

Periodontitis

Untreated gingivitis can progress to periodontitis. Over time, plaque can spread and accumulate below the gum line.⁷ This causes the gums to detach from the teeth, leading to the formation of pockets between the teeth and gums, which can become infected. As the disease advances, the pockets become deeper destroying more gum and bone tissue. Eventually, this can lead to loose teeth that may fall out or require removal.

Periodontal disease is considered one of the most prevalent diseases in humans, characterized by gingival inflammation, loss of gingival attachment, and bone loss.⁶

Causes and risk factors for gum diseases 

There are modifiable and non-modifiable risk factors causing gum problems

Non-modifiable risk factors for gingivitis and associated periodontal disease include age and genetic disorder.⁸

Modifiable risk factors include 

• Poor oral hygiene 
• Smoking or Chewing tobacco
• Genetic predisposition
• Medical conditions such as diabetes, epilepsy, leukemia, etc. 
• High physical and emotional stresses 
• Hormonal changes like pregnancy, puberty, menopause, etc. 
• Vitamin C deficiency 
• Faulty dentistry
• Breathing through the mouth 
• Use of medications like steroids and certain types of anti-epileptic drugs, cancer therapy, calcium channel blockers, and oral contraceptives.
• Toothbrush trauma
• Clenching and grinding of teeth⁶

The primary risk factor that can be changed is poor oral hygiene. When bacteria and plaque accumulate in the smaller spaces between the gum and tooth surface, the body’s inflammatory response to fight infection can unintentionally cause damage to the bone and tissue.⁸

Importance of maintaining good gum health

In maintaining healthy gums it is recommended to:

• Brush twice daily with a good toothpaste
• Floss once daily
• Rinse mouth with good mouthwash after every meal
• Avoid smoking and excessive alcohol consumption
• Manage stress and use a night guard 
• Visit the dentist every six months
• Replace toothbrush every 3 months 
• Take medication only when prescribed

Grape seed extracts: an overview

Source and composition of grape seed extracts 

Grapes are fruits rich in vitamins and fiber. The skin and seeds of grapes contain high levels of Polyphenols specifically proanthocyanidins. These compounds can be used as a functional ingredient to address various health issues by enhancing natural biological processes.⁹

There are various categories of grapes based on their uses such as wine grapes, table grapes, seedless, edible seed, and raisin grapes. Grape seeds can be obtained as a byproduct from any wine manufacturing industry. The seeds of red wine grapes are typically used to produce Grape Seed Extract (GSE).⁹

Key active components (proanthocyanidins, flavonoids, antioxidants) 

Grape seeds are rich in flavan-3-ol, such as proanthocyanidins and catechins.¹⁰ Proanthocyanidin (PA) is a plant metabolite found in various fruits, vegetables, nuts, seeds, flowers, and bark.¹¹

 Proanthocyanidins, which are a type of condensed tannins, are present in grape seed and skin as procyanidins and prodelphinidin. During the fermentation process of winemaking, procyanidins and prodelphinidins are extracted from the seeds and skins.¹²

The seeds of grapes, when dried contain approximately 35% fibre along with 29% extractable components including Phenolic compounds, proteins (11%), minerals (3%), and water (7%).¹³

Grape seed polyphenols exhibit a higher antioxidant activity compared to other well-known antioxidants such as vitamin C, vitamin E, and β-carotene.⁹

GSE is a rich source of polyphenols. Polyphenols and flavonoids found in the GSE are known for their antioxidant properties and ability to act as free radical scavengers.¹⁴

General health benefits of GSE

The polyphenols contained in grape seed have a higher antioxidant activity than other well-known antioxidants such as vitamin C, vitamin E, and β-carotene. Grape seed extract(GSE) also contains enzymes that catalyse the release of histamine during inflammation and allergies.⁹

In addition, grape seed oil also contains a high amount of unsaturated fatty acids such as α-linolenic acid (ω − 3) and γ-linolenic acid (ω − 6) which are associated with reducing the risk of cardiovascular disease, cancer, hypertension, and autoimmune disorders.¹⁵ Additionally, GSE possesses other beneficiary properties including anti-inflammatory, anti-apoptotic, anti-necrotic, cardiovascular, and anti-carcinogenic activities which contribute to its favourable effects against several diseases.⁹

Mechanisms of grape seed extracts in promoting gum health

Antioxidant properties and their role in reducing inflammation 

Inflammation is defined as the body’s response to injuries resulting in swelling, redness and heat at the injury site.⁹ The process of inflammation are mediated by inflammatory mediator’s prostaglandins and leukotrienes.¹⁶

The polyphenolic compounds in GSE have an anti-inflammatory effect. These Polyphenols can inhibit arachidonic acid release, which is responsible for the synthesis of leukotrienes and prostaglandins, as well as the activation of the inflammatory response.¹⁶ As a result, GSE increases the expression of anti-inflammatory cytokines and decreases the expression of pro-inflammatory cytokines, thereby reducing the progression of inflammatory diseases such as periodontitis.¹⁷

Antimicrobial effects against oral pathogens

GSE can inhibit the growth of a broad spectrum of Gram-negative and Gram-positive bacteria depending on its concentrations and the phenolic content.¹⁸ It has been found to have inhibitory effects against Actinomycetes Actinomycetemcomitans, which is the main bacteria strain that causes periodontal disease.¹⁹

Enhancement of collagen production and tissue regeneration

The destruction of tissues in periodontitis results leads to the breakdown of the collagen fibres which make up the periodontal ligament. This results in the formation of a periodontal pocket between the gingiva and the tooth.¹⁷ Grape seed extract (GSE) is a rich source of PA and has been reported to strengthen collagen-based tissues by increasing collagen cross-links supporting the teeth structure.

Application and Usage of Grape Seed Extracts

Available forms (supplements, mouthwashes, gels) 

The by-products of grapes are divided into 3 groups: grape seed oil, grape seed flour/powder, and grape seed extract.

1. Grape seed flour is rich in valuable fatty acids, carbohydrates, minerals, and phenolic compounds
2. Grape seed oil is a valuable product due to its high concentration of unsaturated fatty acids (about 89% of the oil content) and the largest content of linoleic acid (~70-75%)¹⁵. In addition to lipophilic compounds, grape seed oil also contains significant amounts of phenolic compounds, including condensed tannins, flavonoids, and phenolic acids¹⁵
3. The main phenolic compounds in grape seed extract include monomers of catechin and epicatechin as well as flavonols, which are associated with antioxidant, antimicrobial, anti-carcinogenic, and anti-aging properties¹⁵

GSE is available commercially in different forms such as 

• Mouth rinse²⁰ which has been reported to have positive effects on the reduction of dental plaque accumulation
• GSE gel which can be applied on clinically diagnosed periodontal pockets²¹
• Toothpaste containing GSE
• Tablets
• Food like raisins¹

Summary 

GSE offers several health benefits for the body. It can be obtained from various products in different forms and has been shown to be effective against gum disease progression.

However, it's important to note that using GSE to treat gum disease does not replace professional treatment provided by clinicians or dentists. GSE products are used to support healing from gingival issues.